Tetanus: A-to-Z Guide from Diagnosis to Treatment to Prevention

The tetanus vaccine has made tetanus infections rare in the United States. It remains a major cause of illness and death globally.

Introduction to tetanus:

Even though the bacteria that cause tetanus are common in the United States, the vaccine has made infections rare. Nevertheless, tetanus remains a major worldwide cause of illness and death.

What is tetanus?

Tetanus, also called lockjaw, is caused by a toxin created by a bacterium found in the soil. When this germ gets into an open cut or wound, an unprotected person can contract tetanus, which creates serious muscle spasms that can be strong enough to snap the spine. Even with modern medical care, many people who get tetanus die from the disease.

The type of bacteria that causes tetanus is called Clostridium tetani. It is a relative of the bacteria that cause botulism and those that cause clostridium food poisoning.

It is widespread in dirt, especially when the dirt contains excrement.

Who gets it?

Tetanus can be found around the world, but it is most common in warmer climates and in warmer months. The wounds where it enters may be so minor as to be unnoticed, but deep puncture wounds are the most dangerous. People who are immunized are protected.

People can catch it even if the wound is not visibly contaminated. Obvious dirt, stool, or saliva in or on the wound greatly increases the risk.

Neonatal tetanus is another worldwide problem. Unless their mothers have been immunized, newborns can get infected if something dirty touches their umbilical stumps. More than ½ million babies around the world die each year from neonatal tetanus, although this is rare in the United States.

What are the symptoms?

Sometimes “lockjaw” is the first symptom – the involuntary clenching of the jaw muscles. Others begin with headache and irritability, followed by muscle stiffness and then muscle spasms. The muscles are described as rigid as a board. A high fever is common.

Involuntary contractions of the facial muscles create an eerie smile. Contractions of the trunk muscles can bend a person over backward, so that only the back of the head and the heels touch the floor.

Seizures are common, as well as loss of bowel and bladder control. Sadly, the person remains fully conscious, and in extreme pain throughout the illness.

Is it contagious?

Tetanus can be spread by dirty objects such as nails, splinters, or needles.

How long does it last?

Symptoms usually begin within two weeks of the infecting wound and then worsen over a week or so. The worst spasms last for about a week. Those who recover do so gradually over about a month.

How is tetanus diagnosed?

The rigid muscles, intense pain, and classic smile usually make tetanus easy to diagnose. Sometimes the bacteria that cause tetanus can be found in the infected wound, but most of the time lab tests are normal.

Either tetanus or rabies can follow an animal bite, and the initial symptoms may look similar, but the seizures look different in the two conditions. Also, people with rabies often have abnormal lab tests and a fear of water.

How is it treated?

To treat tetanus, people are often paralyzed and then put on a mechanical ventilator to keep them breathing. Muscle relaxants and anti-seizure medicines are important.

Treating tetanus also involves ridding the wound and the body of any remaining bacteria and ridding the body of the toxin. This usually means giving tetanus immune globulin (TIG), antibiotics, and then surgically removing an area of tissue around the wound.

How can it be prevented?

The tetanus vaccine is very effective at preventing tetanus. This is part of the regular childhood immunization series. The T in DTaP is a tetanus vaccine. Boosters are given after all wounds and animal bites if the person is not known to have at least 3 of these shots, and if the last proven shot has not been within 5 to 10 years (depending on the wound). Thorough wound cleaning is also important.

Newborn tetanus can be prevented by being sure that mothers have been properly immunized.

Some parents find it desirable for their children to have pierced ears as babies. But how early is too early? Even though tetanus is not very common (thanks to immunizations), the tetanus bacteria are everywhere. For this reason, it is best for a baby to have at least one (even better, three) tetanus shots behind her before her big day. Three shots would put the event at 6 months old for most kids.


Last medical review on: January 07, 2014
About the Author
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Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
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